Help-seeking behaviors among survivors of intimate partner violence during pregnancy in 54 LMICs

Abstract Background Intimate partner violence (IPV) experienced by pregnant women is pervasive worldwide. As survivors rarely seek help, there exists a paucity of research on their help-seeking behaviors. The present study provides a multi-national perspective into the nature of help-seeking behaviors among survivors of IPV during pregnancy. Methods Population-based data from 54 LMICs were abstracted from the Demographic and Health Surveys Program between 2005 and 2020 (N = 359,027). Bivariate and multivariable logistic regression were used to analyze the extent to which - and from whom - survivors of IPV during pregnancy sought help and assess associated factors. Results Half of respondents (51.87%) sought help following IPV while pregnant (ranging from 39.02% in Asia and Oceania to 63.18% in sub-Saharan Africa). Support was primarily obtained from informal contacts (44.02%), such as family, neighbors, and friends, and rarely from formal institutions (10.45%), such as law enforcement, social and medical services. Help-seeking behaviors were positively associated with higher education, employment, earnings exceeding that of their spouse, exposure to mass media, intimate partner's alcohol consumption, fear of their intimate partner, parental violence, richer wealth status, partner's controlling behaviors, and facing barriers to access health care. Conversely, being married, and justifying wife beating were negatively associated with help-seeking. Conclusions The research findings highlight the need for interventions, ranging in scope from the individual to familial and societal levels, to increase and improve help-seeking opportunities for IPV survivors. Efforts should be made on strengthening women's decision-making capacity, reducing poverty, ensuring educational attainment, improving employment opportunities, disseminating information about help sources, IPV screening within health care, and promoting the diffusion of gender equality by engaging communities as a whole. Key messages • IPV during pregnancy is still pervasive in LMICs, and only half of survivors seek help. Women’s individual, partner’s/family’s, and community’s factors are associated with IPV survivors’ help-seeking. • The research findings highlight the need for interventions, ranging in scope from the individual to familial and societal levels, to increase and improve help-seeking opportunities for IPV survivors.


Background:
Lay and professional people may use terms for mental health and mental health problems differently, causing difficulties in adequately addressing associated needs. Despite the public health issue of increased mental health problems among adolescents, there is limited research on perceptions of mental health concepts among young people. This study aimed to explore conceptual views of mental health and mental health problems among adolescents. Methods: During October and November 2020, a total of 32 adolescents (15-18 years old) living on Sweden's largest island Gotland were interviewed in focus groups or individual interviews. The interviews were semi-structured and audio recorded. Data were analysed thematically according to Systematic Text Condensation.

Results:
Three themes emerged from the analysis: Mental health is about how we feel; One's mental health depends on one's situation, thoughts and ways of coping; and Mental health problems should be taken seriously and can get severe. The adolescents described mental health as an overarching concept encompassing both positive mental health and mental health problems. Mental health problems were perceived as something other than normal challenges in life, however ranging from minor problems to severe illness. Good mental health was understood as a condition with absence of mental health problems and presence of symptoms of positive mental health.

Conclusions:
The adolescents' had a complex and holistic understanding of mental health concepts, consistent with definitions used by the World Health Organization and Swedish authorities. They suggested both positive mental health and mental health problems to be considered when assessing and discussing their mental health. Further, the results highlight the need of support for young people on how to cope with difficulties in life and support for those suffering from minor mental health problems.

Key messages:
The adolescents' understanding of mental health and mental health problems were highly consistent with current accepted definitions of the concepts. According to the participants, both positive mental health and mental health problems should be considered simultaneously to understand and address adolescents' mental health.

Background:
Intimate partner violence (IPV) experienced by pregnant women is pervasive worldwide. As survivors rarely seek help, there exists a paucity of research on their help-seeking behaviors. The present study provides a multi-national perspective into the nature of help-seeking behaviors among survivors of IPV during pregnancy.

Methods:
Population-based data from 54 LMICs were abstracted from the Demographic and Health Surveys Program between 2005 and 2020 (N = 359,027). Bivariate and multivariable logistic regression were used to analyze the extent to which -and from whom -survivors of IPV during pregnancy sought help and assess associated factors.

Results:
Half of respondents (51.87%) sought help following IPV while pregnant (ranging from 39.02% in Asia and Oceania to 63.18% in sub-Saharan Africa). Support was primarily obtained from informal contacts (44.02%), such as family, neighbors, and friends, and rarely from formal institutions (10.45%), such as law enforcement, social and medical services. Help-seeking behaviors were positively associated with higher education, employment, earnings exceeding that of their spouse, exposure to mass media, intimate partner's alcohol consumption, fear of their intimate partner, parental violence, richer wealth status, partner's controlling behaviors, and facing barriers to access health care. Conversely, being married, and justifying wife beating were negatively associated with help-seeking.

Conclusions:
The research findings highlight the need for interventions, ranging in scope from the individual to familial and societal levels, to increase and improve help-seeking opportunities for IPV survivors. Efforts should be made on strengthening women's decision-making capacity, reducing poverty, ensuring educational attainment, improving employment opportunities, disseminating information about help sources, IPV screening within health care, and promoting the diffusion of gender equality by engaging communities as a whole. Key messages: IPV during pregnancy is still pervasive in LMICs, and only half of survivors seek help. Women's individual, partner's/ family's, and community's factors are associated with IPV survivors' help-seeking.

Background:
The prevalence of intimate partner violence (IPV) in Tanzania is one of the highest in the sub-Saharan African region. Studies have shown that traditionally ''manly'' behaviours, such as risk-taking, are at the root of IPV perpetration. Only few studies investigated the co-occurrence of gambling and IPV, and none from LMICs.

Methods:
Cross-sectional survey data of 1002 men aged 18-24 from Mwanza, Tanzania were analysed. Physical, sexual, emotional and economic IPV perpetration were measured using actsbased questions. Gambling was assessed through a question on whether the man bet or spent money on gambling or gambling machines. Consequences of gambling behaviours were assessed through four further questions. We conducted multivariate logistic regressions to control for potential confounders.
Results: 21% of the men in the sample confirmed they had bet or spent money on gambling in the previous 12 months; the prevalence raises to 24% for men who had been in a relationship in the previous 12 months (N = 755). Of these, 23% had ever perpetrated physical IPV, 29% sexual IPV, 56% emotional IPV and 37% economic IPV in their lifetimes. Of those who gambled, 24% had ever perpetrated physical IPV, 46% ever committed sexual IPV, 66% emotional IPV and 45% economic IPV. Gambling was statistically significantly associated sexual IPV (aOR: 2.39; 95% CI: 1.66-3.45) and emotional IPV (aOR: 1.48; 95% CI: 1.03-2.14) even after controlling for age, alcohol use, depressive symptoms and suicidal ideation. Gambling was not associated with physical and economic IPV after adjusting for those confounders.

Implications:
The analysis shows that young men's practice of gambling is an additional risk factor for IPV perpetration that needs to be addressed. More research is needed to understand how current prevention efforts can be expanded to include problem gambling treatment to curb the incidence of IPV and give couples conflict resolutions skills for issues that might arise from gambling. Key messages: Problem gambling has so far remained vastly underresearched in violence research. Gambling as well as drinking were associated with increased odds of physical and sexual IPV perpetration.
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